Biosurveillance Opportunities Prepared & Presented by Cynthia Harry, MSPH, Epidemiologist, Oklahoma City-County Health Department (OCCHD) & Dean Lampman, MBA, Regional Surveillance Coordinator, Southwest Center for Advanced Public Health Practice (APC) 73rd Annual Oklahoma Public Health Association Conference April 5-6, 2012 Embassy Suites, Norman, OK 1
Session Agenda • Surveillance Systems Overview • Advanced Practice Center (APC) Products • TCPH Child Health Surveillance Program • OCCHD School & Health Surveillance Program • OCCHD QI Evaluation of APC Product • Our Meaningful Use Opportunity • Conclusions / Recommendations • Questions / Answers Biosurveillance Opportunities 2
Surveillance Defined Ongoing systematic collection, analysis, and interpretation of health data in the process of describing and monitoring a health event or events www.cdc.gov/ncphi/disss/nndss/syndromic.htm Biosurveillance Opportunities 3
Syndromic Surveillance Defined Regular collection, analysis, and interpretation of real-time or near-real-time indicators of disease and other outbreaks by public health http://faculty.nps.edu/rdfricke/docs/SyndromicSurveillanc e.pdf Biosurveillance Opportunities 4
Syndromic Surveillance Benefits • Health data preceding diagnosis –Best if it’s near real-time • Facilitates public health response: –Signals if case/ outbreak is significant –Allows ongoing tracking of outbreak –Supports collaboration with providers Biosurveillance Opportunities 5
What’s Under the Hood In systems such as ESSENCE ... • Algorithms used to classify data – Free text and/or ICD9 codes – Cast in syndromes and medical subgroups • Analyzes all categories for anomalies – Temporal or spatial – Check vs. expected values • Automated reports, alerts for anomalies Biosurveillance Opportunities 6
How Partners Share Data • Data use agreement has ‘HIPAA’ coverage for data elements to be shared • Contract amendment if elements change • Assess network connections and transfer methods: typically VPN and HL7, but can vary • Identify and link to interfaces • Send test files, work out mapping • Project time varies, but can be “It’s not rocket science!” accurately estimated; isn’t “huge.” Biosurveillance Opportunities 7
Child health surveillance Helps: • Monitor flu activity • Assess impact of disease • Detect pandemic or epidemic • Slow flu with > awareness • Allocate resources Biosurveillance Opportunities 8
Why focus on youth? • Accelerate flu transmission • Biologically more susceptible • One of 3 high-risk groups • Impact rest of household • Flu-friendly environment Biosurveillance Opportunities 9
ILI data’s importance • Aggregated data can mask trends • Total absenteeism is insufficient • Reveals reasons for absenteeism • More precisely characterizes flu • Provides actionable information ILI has 2 key symptoms: 1) Temperature >100 ° & 2) Cough / sore throat w/ no other known cause. Also may involve malaise and muscle aches, runny nose, chills or headache. Biosurveillance Opportunities 1 0
What public health must address 1. Data types [ < or = meaningful use] 2. Technical standards for connection 3. Data quality, accessibility 4. Response protocols 5. Cost-effectiveness 6. Scalability, longevity 7. Community of practice Biosurveillance Opportunities 1 1
Session Agenda • Surveillance Systems Overview • Advanced Practice Center (APC) Products • TCPH Child Health Surveillance Program • OCCHD School & Health Surveillance Program • OCCHD QI Evaluation of APC Product • Our Meaningful Use Opportunity • Conclusions / Recommendations • Questions / Answers Biosurveillance Opportunities 1 2
APC Program and Network • Launched in 1999 by NACCHO, CDC • Package work of a few exemplary LHDs • Build, share innovative, practical tools • Created by LHDs for LHDs • APC network completed 100+ products • All free emergency preparedness tools Biosurveillance Opportunities 1 3 1 3
APC – PHEP Alignment Project • Conducted in summer 2011 • Reviewed 94 APC products (now 109) • Self-assessment by the 8 APCs • APCs: LHDs, PHEP: local & state PH • APC products align: – To all 15 of the PHEP capabilities – With 100% of functions for each capability – With 90% of capability components Biosurveillance Opportunities 1 4 1 4
Tarrant County APC • Formed Fall ’03 by NACCHO, CDC • Regional focus – DSHS Region 2/ 3 • 16 products, mostly in 3 areas: – Disease detection, investigation – Emergency preparedness, assessment – Workforce training, development Biosurveillance Opportunities 1 5 1 5
Biosurveillance Resource CD • Comprehensive • Lessons learned • Case studies • Flexible • Many resources • Peer reviewed Biosurveillance Opportunities 1 6 1 6
School Health Surveillance Kit • CIDRAP Promising & NACCHO Model Practice • Used in novel ways (including childcare data) • 4 case studies (OH, KS & TX) Biosurveillance Opportunities 1 7 1 7
Session Agenda • Surveillance Systems Overview • Advanced Practice Center (APC) Products • TCPH Child Health Surveillance Program • OCCHD School & Health Surveillance Program • OCCHD QI Evaluation of APC Product • Our Meaningful Use Opportunity • Conclusions / Recommendations • Questions / Answers Biosurveillance Opportunities 1 8
School surveillance goals 1. Apply biosurveillance to PH practice 2. Respond to surveillance clues 3. Target flu shots, specimen sampling 4. Campus data, not just district data 5. Daily rather than weekly data 6. No vacuum cleaner approach Biosurveillance Opportunities 1 9
TCPH’s key partners • Dr. Tabatha Offutt-Powell • Tarrant County APC • Texas DSHS • Ingen Systems • School nurses Biosurveillance Opportunities 2 0
System elements • Electronic reporting via Web portal – Student absences, flu-related absences – Nurse perpection of ILI – School closure & reasons – Faculty absences and ILI – Comment box and feedback support • Maps, resources and data for nurses – Appropriate for a flu prevention campaign Biosurveillance Opportunities 2 1
SHSS data flow Form takes < 5 min SQL DB on DNN Data entry form on ESSENCE open DB @ TCPH source portal (DNN) These fields optional Royalty free ESSENCE application CDC definition of ILI given
Secure log in with no registration link to ease account management and avoid duplication
Role-based security lets you serve up unique content to different groups. Landing page offers simple menu, data form, action items, news, and a wealth of resources 2 4
ESSENCE maps of flu and ILI patterns by region. You can click on each image to see a larger view. Maps show the county and quadrants of the county.
Sample ILI map of Tarrant County using ESSENCE hospital ED data Next / previous = other images. Close = back to main maps page .
Users can access flu prevention resources. More can be added easily. RSS is supported. Users can view and edit their reports using a drop-down box for each school. Charts & cross tabs allow limited in-system data analysis.
We use a custom blog module, Nuke Press, to post news. User comments capability is inactive. Biosurveillance Opportunities 2 8
Selected evaluation findings • Simple design, minimal data worked • Collected in < 30 min., sent in < 5 min. • Difficulty with “reason for absence” • Participation sufficient and stable • Statistically valid, representative data • More work needed with childcare centers • Complements other data sources Biosurveillance Opportunities 2 9
Session Agenda • Surveillance Systems Overview • Advanced Practice Center (APC) Products • TCPH Child Health Surveillance Program • OCCHD School & Health Surveillance Program • OCCHD QI Evaluation of APC Product • Our Meaningful Use Opportunity • Conclusions / Recommendations • Questions / Answers Biosurveillance Opportunities 3 0
OCCHD’s Initial Project Goals • Build community relationships w/ schools • Recruit schools across county for reporting • Construct Website for daily reporting • Send data to syndromic surveillance system Biosurveillance Opportunities 3 1
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Transcending School Health • Facilitate communication between many community partners & OCCHD • Inform community on disease trends • Disease control, prevention resources • Build other community relationships • Fill in a spectrum of useful data: – OTC, EMS, urgent care centers, EDs, schools, dental, veterinarians, water, poison control Biosurveillance Opportunities 3 8
Session Agenda • Surveillance Systems Overview • Advanced Practice Center (APC) Products • TCPH Child Health Surveillance Program • OCCHD School & Health Surveillance Program • OCCHD QI Evaluation of APC Product • Our Meaningful Use Opportunity • Conclusions / Recommendations • Questions / Answers Biosurveillance Opportunities 3 9
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